- East African countries on Wednesday marked Africa Malaria Day by announcing a review of control strategies, ranging from the use of more effective drugs to indoor spraying with DDT.

In Tanzania, the government launched an anti-malaria combination drug, artemether-lumefantrine, at a ceremony in Bukoba in the country's northwestern region of Kagera.

"Drugs which were formerly used for treatment of malaria, including chloroquine and SP [Sulfadoxine/pyrimethamine] have proved ineffective and the government banned them," Health Minister David Mwakyusa said. "We are going to ensure strict enforcement of the ban. Only approved drugs should be imported into the country."

Noting that the rate of malaria infection in Tanzania was "unacceptably high", the minister said between 16 and 18 million cases were reported every year, leading to more than 100,000 deaths, of which about 75 percent occur among under-five children and pregnant women.

"Malaria accounts for 30 percent of the national disease burden, 43 percent of national under-five out-patients’ attendance and 37 percent of deaths," he said.

In Kenya, free indoor residual spraying is to begin in malaria-prone areas, the government said. "The government has today officially launched the indoor residual spraying campaign to benefit around four million Kenyans in the western highland areas to prevent possible malaria outbreaks," said Health Minister Charity Ngilu.

Residual spraying, she explained, was part of the prevention strategy after weather forecasts warned of heavy rainfall in the western highlands.

Malaria is the leading cause of morbidity and mortality in Kenya and about 34,000 children die annually from malaria-related causes, while a large number of pregnant women living in malaria endemic areas regularly suffer severe complications such as still-births and miscarriages, according to the health ministry.

"This campaign will focus on the reduction of child and maternal deaths and the burden of malaria," said James Nyikal, Kenya's director of medical services.

The campaign involves the application of a synthetic pyrethroid with a residual effect on the internal walls and ceilings of houses to kill malaria-transmitting mosquitoes in 680,000 housing units within the next 60 days.

According to Nyikal, the method relies on the fact that most malaria vectors enter houses at night and rest on walls before and after feeding. If the walls and roofs are treated with an effective residual insecticide, the mosquitoes pick up a lethal dose and die soon after.

"In selecting the insecticide, the Ministry of Health took into consideration the safety of the inhabitants of the sprayed houses, the spray men, domestic animals and the environment," he said.

In Uganda, authorities said they would start the phased spraying of DDT in August, and expect to reduce the malaria burden by half in two years.

The malaria control programme manager in the health ministry, John Bosco Rwakimari, told IRIN that the programme would start in the southwestern districts of Kabale and Kanungu. Camps for internally displaced persons in the north are also targeted.

"The environment impact assessment was done and the environment authority cleared us to use DDT and we are waiting for the right season to start because we cannot spray during rainy seasons," he said.

There has been controversy over the Ugandan government’s desire to use the controversial DDT, known scientifically as chlorodiphenyl-trichloroethane, an insecticide banned in many countries, under its anti-malaria programme.

According to Rwakimari, about 95 percent of Uganda's population is exposed to the risk of perennial malaria transmission. The disease kills between 70,000 and 110,000 people annually, and is responsible for 30 to 50 percent of all outpatients in health facilities.

"If we are to carry out spraying, 50 percent of the burden will go and if the process was to be repeated annually, 90 percent of the burden will have been weeded off," he added.

In southern Sudan, a procession of mothers and children 'marched' against one of Africa's biggest killers from Juba University to Juba Football Stadium where they set up banners against 'monstrous malaria, great killer of our children' in the stadium grass made lush by the arrival of rains.

John Rumunu, Director-General for preventable diseases in southern Sudan's Health Ministry, said the day was also being used to officially open the USAID-funded malaria control programme offices.

"We have reached a lot of our milestones; a control policy and strategy plan is in place now," said Rumunu. His ministry was only formed in 2005, after the peace agreement that ended more than two decades of fighting in the south. "Methods for curing malaria like chloroquine are no longer effective, so we chose to use Artemisinin combination therapies since last year."

Non-governmental organisations and health agencies operating in southern Sudan, he added, were now using the combination therapies. "Malaria is such a complex illness it is difficult to talk about eradication but you can dramatically reduce infection and improve case management," said Garfield Jones of the Malaria Consortium.

According to UN estimates, between 350 million and 500 million people are infected with malaria each year, of whom one million die. Malaria accounts for one death every 30 seconds in Africa alone.

In much of Africa, malaria strains already overburdened health systems. The majority of cases occur in children under the age of five. Malaria-infected pregnant women are also at risk of contracting anaemia, putting their lives and those of their unborn children at risk.

In addition, weakness caused by the disease in adults can severely impair their ability to work, perpetuating the cycle of poverty.

Malaria is deadly but there are ways to treat and prevent it. At a cost of just US$10 each, for example, insecticide-treated bed nets have been shown to reduce malaria deaths by up to 20 percent, with each net lasting up to five years.

Africa Malaria Day was established by African heads of state at the Abuja summit on 25 April 2000 to intensify the fight against malaria. This year’s slogan is ‘Free Africa from Malaria NOW!’

"This year's slogan recognises the urgency in intensifying the war against malaria; about 80 percent of the Kenyan population is at risk of getting this disease and this has contributed greatly to slow economic growth," said Kenya’s Ngilu.

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